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Bar Code Medication Administration and MAR Resource Manual

Basic Information

Glossary of Terms........................................................................................................................... 2 MAR Summary ................................................................................................................................ 5

MAR Summary – Frequently Asked Questions ............................................................................. 8 Changing MAR Summary Defaults ................................................................................................ 9 MAR Tab ....................................................................................................................................... 10

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Glossary of Terms

Care Mobile: Cerner software package that interfaces with PowerChart to allow scanning and charting with a mobile device; the Cerner application used to communicate with the PDA.

Chart not done: used to chart on the MAR, meds that have been omitted based on clinical

guidelines, orders (low pulse or BP), duplicate administration (already taken at home), or pt . refusal.

Create an administrative note: used on eMAR (not on PAL) to note patient preferences; displays in Care Mobile.

Cross encounter: patient data from one admission will appear on the next admission’s chart, depending on the tab and search criteria set in PowerChart; medication tasks can carry over to the PAL but not to the MAR or CareMobile.

Diluent: the base solution in which IVPB medications are mixed, such as D5W or NS; when scanned, the meds and diluent are recorded on the MAR and I&O.

Drop down menu selection: the button with a drop down arrow on the PDA used to select

patient list or medication list

Drop-down menu list

Due tasks: currently due meds. Display meds 1 hour prior to due time to approx.. 30 minutes to 1 hour after med is due

Overdue tasks: meds that are past due 30 minutes

Continuous IV’s: IV ‘s ordered to run continuously

Sched Meds: due meds and overdue meds.

Sched Pt Care: scheduled patient related tasks,

such as vitals signs

PRN Meds: med orders available for administration as needed

PRN Pt Care: optional patient related tasks

Unscheduled Meds: one time meds for which

administration time is not known, such as pre-op

Resp Therapy: Respiratory Therapists’ med list

To be Signed: completes charting process; signing occurs after scanning meds and completing PPID

Discontinued: a list of discontinued tasks for 24 hours

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EMAR: electronic Medication Administration Record.

Enter Orders through Ad Hoc: used to enter Stat and Now orders of floor stock meds; the

nurse enters the order so the med and patient can be scanned; the med is given without Pharmacy review, presenting a potential safety issue.

Icon: pictorial short cuts that open specific applications or programs.

Image reader: the scanner part of the PDA (see Scanner)

Indicator: a pictorial symbol that alerts the user to certain information. For example, the eyeglasses indicate that the medication order has not been Nurse Reviewed; the symbol does not open when tapped.

Label: the manufacturer’s packaging or sticker applied in Pharmacy containing drug dose, description and UPC code; also the patient ID band.

Locked MAR: the charting function on the eMAR will be locked (unavailable); all medication

charting will be done through CareMobile. The information charted using the PDA will be viewable on the eMAR. The eMAR will be unlocked following periods of PowerChart downtime so that meds may be back charted. Some departments, such as IV Therapy, ED and Dialysis

will chart on the eMAR

MAR: Medication Administration Record tab in PowerChart where medication information displays. Synonymous with eMAR

Near code: an emergent patient condition that requires rapid med administration; the nurse

administers meds without scanning drug or patient (see Retrospective Charting.)

Not Given: used to chart meds that have been omitted based on clinical guidelines, orders (low pulse or BP), duplicate administration (already taken at home, etc.), or patient refusal.

PDA: Personal Digital Assistant. A hand-held wireless computer that allows the clinician to scan patients for Positive Patient Identification (PPID) and to scan and chart medications in PowerChart.

Tap: selects an option or places the cursor in a field; equivalent to left-click mouse

function Tap and Hold: opens a short cut menu; equivalent to right-click mouse function

1st time login: the first time a user logs into a PDA, the device needs to load settings; occasionally this requires the user to enter his or her password a second time Load settings: the period of time following login when the PDA readies itself for use

PMAR: paper medication administration record; used during periods of PowerChart downtime.

PPID or Positive Patient Identification: at Munson, PPID includes scanning the patient ID band and asking able patients to state his or her name and birth date.

Range Dose Administration: for orders with a dose range, for example: for Morphine 1-

10mg PRN, IVP, the nurse must enter the dose and unit of measure dose.

Reader: the scanner part of the PDA (see Scanner).

Remove: an option to take a patient off a custom list or to remove a medication from the ‘To be Signed’ list (before signing.)

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Retrospective charting: back charting a period of time after the medication has been

administered; the med packaging is no longer available for scanning; retrospective charting will

be done following PowerChart downtime and near-code situations.

Save: the step prior to signing when in a charting window. When saved, the information goes to the “To be Signed” list.

Scanner: the Scan button on the PDA emits the laser light needed for barcode reading; a beep will sound when scanning is complete.

Sign: the final step of the bar coding medication administration process, done after PPID and drug administration; charts the medication in the patient record.

Symbology: refers to the different UPC codes that display on labels; “linear” and “two dimensional” are two of the UPC codes that exist on product packaging.

Task Bar: the bottom bar on the PDA screen

Workflow: tap on Workflow for Exit option Tasks: tap on Tasks for List Maintenance option

Tasks: a general term used in PowerChart and CareMobile that refers to work or interventions to be done for the patient; there are many different tasks found in PowerChart and CareMobile. Medication tasks are on the PAL and listed in CareMobile (see picture of drop down menu

selection above for task examples.)

Time Charted: time the medication task is signed

Time Out: when the CareMobile application is left inactive beyond set parameters, the user is returned to the login screen and presented with the message: “The application has timed out

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MAR Summary

MAR Summary is a separate tab within PowerChart that will enable clinicians to see med administration information in a condensed view. It provides:

A high-level view with easy access to more detail.

Concise med information, including pending, given, not given, and overdue medications.

Features:

Reverse Chronological order

Hovering to display more detail

Legend of indicators that appear for any order or result

Links to order or result details

Use of color to indicate pending/overdue/given/not given

Ability to change settings (time frame, time columns, sections, IV events) and store

preferred defaults

Ability to filter by section (scheduled/unscheduled/PRN/continuous infusions) and/or by

active/inactive orders

MAR Summary: 4 Sections:

Scheduled

Unscheduled

PRN

Continuous Infusions

24 hour intervals Search criteria:

48 hours back

8 hours forward (see next page for customizing)

Selected encounter only

Midnight start-of-day

Color-coding:

Blue: pending

Red: overdue

White: given

Yellow: given

Orange border: not given/not done

Hover for more detail:

Order detail

Status

Icon legend

Administration detail

Overdue

Given

Pending Not given

Current time column is highlighted in yellow

Reverse Chronological order

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Customizing:

Click on Navigator button, then select Change Properties Date Range tab:

Date

Column time intervals

Filters tab:

Sections

Display inactive orders

Options tab:

Pending doses

Continuous infusions

Save As Default Note: selecting Infuse (Volume Documented) will display infused volumes charted on I&O on the MAR Summary

Change Interval

Select number of hours to display in time column

Navigate to sections

Quickly move to specific section

Changing defaults:

Right-click on blue search criteria bar

Select Change Defaults

Hours back Hours forward Column Time Interval Day begin time Font size

Click OK

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Scheduled meds

Displays administered dose and time

Pending dose time displays

PRN medications

Multiple doses may list in one cell, depending on column intervals

Hover on cell to display details

Continuous and Titratable IVs

Hover on cell to display details for each ingredient

Allows access to View Details screen

Infused volume charted on I&O tab displays

Inactive Orders

Display with gray background

Charting patient’s response to PRN med is pending; when charted it will not display on MAR Summary. Data will display on MAR, Patient

Assess flowsheet and Forms tab.

Given Pending

Multiple

doses

Result Comment: to view, click

on Details, then Comments tab

Overdue

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MAR Summary – Frequently Asked Questions

I don’t see a dose that I know was given.

* Change search criteria dates/times * Click the Refresh button

What do different colors/indicators

mean?

* Hover to view details including indicator description and medication

status

I have to scroll too much.

* Change column intervals to a larger interval * Change date range * Click on Navigator button and use ‘Navigate to’ option to go quickly to a

section

How do I know

who gave a med or IV?

* Hover over cell

Why use MAR Summary instead of the MAR?

* MAR is a high level overview * MAR Summary provides a more condensed view and more detail than MAR

* Can filter off sections, change defaults on MAR Summary

How do I know site

of injection? * Hover over cell; if charted will display

Why don’t I see all

of my sections? * Change your Properties to include sections you want displayed

Why can’t I see a

pain response?

* Only PRN responses yet to be charted display; once charted, data may

be viewed on the Assess flowsheet or the Forms tab

What do I need to

do to see IV infused volumes in the continuous IV

section?

* Click on the Navigator button and select Change Properties. Go to the Options tab and select Infuse (Volume Documented). Also select Save as Default if you always want to view infused volumes.

Can I change my view to match my unit’s usual shifts?

* Yes. Right-click on the search criteria bar and select Change Defaults. Click the dropdown arrow next to Column Time Intervals and select the desired number of hours. Then change the Each Day Begins At time.

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Changing MAR Summary Defaults

1. Go to MAR Summary tab

2. Click Options on the Menu bar

3. Click Change Defaults

4. Make changes

5. Click OK to apply defaults

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MAR Tab

The MAR (Medication Administration Record) tab displays a patient’s medication orders and documented administrations for the selected time frame and selected order status’.

Medications will display when a Provider has entered the order into PowerChart or Pharmacy has entered them into the PharmNet application. The MAR tab includes scheduled, unscheduled and PRN medications, continuous infusions and a discontinued section.

Time Frame Selection

The MAR tab time frame default is the current 24 hrs and the previous 24 hrs. To change your time frame, right- click on the Search Criteria bar, select Change Search Criteria and enter the

desired time frame. You may also select Set to Today.

Order Status Filters

To change the types medication orders displayed on the MAR tab, click Options on the Menu

bar. Click Filters. Select or deselect the order status’ to include by clicking in the box.

Click Filters

Click Options

Click box to select

or deselect

Search Criteria bar

Right-click

Click

Select time frame

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Navigator and Medication Sections of the MAR

The Navigator on the MAR tab allows you to move within the Medication Section by clicking the various medication categories (the ‘Future’ category is not used). The Medication Section displays the patient’s medications and associated order details. The time frame and filters

selected determine which medications will be listed. Administration dates and times are displayed to the right on the same row. The current date and time column is highlighted in yellow.

Medication Section icons

Med Order Section

Navigator

Administration columns

Nurse Review – the order has not been nurse reviewed.

Admin Note – click to view previously entered notes for this medication.

Pharmacy Comment – Click or hover to view comments entered by Pharmacy for this

medication.

Linked medication – Hover to view details; info is also listed with the medication details.

Request Pharmacy Verification - The medication order has not been verified by Pharmacy.

The med is approaching its stop date/time. Right-click to view order details.

The med is approaching its stop date/time. Right-click to view order details.

The med is approaching its stop date/time Right-click to view order details.

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Right-click options in the Medication Order section

The following options are available by right-clicking the medication order:

Administration column indicators - Viewing

Right-click options in the Administration section

The following options are available by right-clicking the medication task cell:

Click to view general

details of the order

Click to view/print Drug Reference

material

Click to send Med Request to Pharmacy. Reason field must be completed for the request to print in Pharmacy. Enter short message

in the comment field if needed.

Click to chart a communication note to another nurse or view previously entered notes for this medication. Make sure to include your initials

when entering an Admin Note.

This option is for IVs only. Click to view bag #, date/time, site, rate, and

who it was performed by.

Medication task – displays in the d/t column when it is due.

Comment indicator (blue background). Right-click to view comment.

Displays in the current d/t of the PRN administration column (green background). ‘Not

previously given’ will display if appropriate.

Medication was not given (blue background). Hover to view reason.

MAR note – reminder to chart data.

Administered medication (blue background).

Administered medication (gray background with blue √). After clicking As Of, the

medication dosage is listed in the appropriate d/t column.

Medication was uncharted (blue background). Right-click to view comment.

Medication was not given (blue background). Hover to view reason.

Use for meds administered on non-eMAR units (OR, PACU), if med not

given or for Not Given on IVPBs.

Click to view general details of

the order +/or task

Use for meds given prior

to their scheduled time

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Right-click options for a charted medication

View Details – Click to view medication and administration details. View Comments – Click to view comments. View Order Info - Click to view general details of the order.

Add Comment – Click to add comments. Modify – Click to modify charted details.

NOTE: If you modify the date +/or time of a medication that generates a Pain Response task,

and the Pain response task has not been completed, the Proposed Modifications window

displays:

If the proposed date/time are appropriate, click to highlight and click OK. The task will then display in the new date/time column. If you click Cancel, the Pain Response task remains at the original date and time.

Do not use

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When the Pain Response task has been completed prior to the modification, the New Response Task window opens.

Click OK. Pain Reassessment form opens. Click the Cancel Charting button. On the MAR, right – click on the task and select Chart Not Done. Enter a reason of inappropriate at this time.

NOTE: The charted pain reassessment may need the time changed.

Unchart – Click to unchart a medication. Uncharting will return the medication to its previous

status of due, overdue, etc. and mark it as ‘In Error’.

NOTE: If you unchart a medication that has a documented pain response, a warning

displays indicating that the pain assessment may also need to be uncharted.

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Charting on a unlocked MAR following Downtime During periods of scheduled or unscheduled PowerChart downtime, medication charting will be

done on the pMAR. When PowerChart becomes available the MAR tab will be ‘unlocked’ to allow downtime charting. All medication documentation done on the PMAR will be back charted in PowerChart through the MAR tab or PAL.

Unlocked MAR

Administration Column Indicators

Navigator

Med Order Section Administration Columns

Overdue medication (red background).

Administered medication (gray background with blue √). After clicking the Refresh button,

the medication dosage is listed in the appropriate d/t column.

Comment indicator (blue background). Right-click to view comment.

Medication is due (blue background). Displays in the date/time column that the med is due.

Displays in the current date/time of the PRN administration column (green

background). ‘Not previously given’ will display if appropriate.

MAR note – reminder to chart data (blue background). Only displays when Pharmacy enters a PCA note order.

Administered medication (blue background).

Pain response task – displays in PRN category 5 min after a PRN medication is

charted (blue background). Click to chart response.

Medication was not given (blue background). Hover to view reason.

Medication was uncharted (blue background). Right-click to view comment.

Medication was not given (blue background). Hover to view reason.

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To chart on the MAR tab, click the medication in the Administration column:

The medication charting window displays. Verify information, make changes, complete any required fields and sign.

NOTE: When back charting, verify that the Performed date/time and the Performed by fields are accurate.

Right-click options in the Administration section

When the MAR is unlocked to allow charting, 2 additional options are available on the drop down list: Chart Details and Quick Chart.

Chart Details opens the charting window for changing the time or other chart details. Chart as

you would in Care Mobile. Quick Chart signs the med task without opening the charting window. The medication will

have the due time and all other details associated with the task.

Click medication task

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1. Enter your user name in User Name field. The next time the PDA is used tap the drop-

down arrow. The last 7 user names will display. Tap your user name if listed.

2. If keyboard does not open, tap Keyboard icon.

3. Tap Password field and enter password.

4. Tap OK.

5. Occasionally an Alert opens informing user that he/she has never logged into this device.

6. Tap OK. 7. The log in window opens again requiring you to enter

your password again.

8. Tap OK after entering your password.

Your patient lists will not display in CareMobile the first time you log into CareMobile. See the following page to create lists.

Keyboard Icon